What if I do not agree with the doctor's
rating or the date of maximum medical improvement?
If you disagree with the doctor's impairment rating or the date of
maximum medical improvement, you may request an Independent Medical
Examination (IME). If you are objecting to a Final Admission of
Liability, you must send in your objection and propose the name or
names of a Level II accredited physician within 30 days of the date
of the final admission. A Level II accredited physician has received
special training through the Division of Workers' Compensation to
evaluate permanent impairment under the law. The cost of this
examination is usually $675.00 and is paid by the party requesting
the IME.
The following is a brief summary of the IME process:
1. The party requesting the IME (requester) must complete the
Notice and Proposal for Independent Medical Examiner
form. See the
Accredited Physician List
to propose the name or names of a Level II accredited physician. The
requester must send this Notice to the other party. If you are the
claimant, the other party is the insurance carrier. If you are the
insurance carrier, the other party is the claimant or claimant’s
representative, if applicable.
2. The parties have 30 calendar days to negotiate the selection of
the Independent Medical Examiner (physician who will conduct the IME.)
The requester needs to obtain an
Application for Independent Medical Examination (IME),
form (WC77), during this time.
3. If the parties agree on the Independent Medical Examiner, the
requester must schedule the examination promptly with the physician.
The requester must also complete the Application for IME form and
submit this to the Division of Workers’ Compensation and the other
party.
4. If the parties do not agree on the Independent Medical Examiner,
or there is no response to the Notice and Proposal, the insurance
carrier must complete the
Notice of Failed IME Negotiation,
form (WC 165). A copy must be sent to the Division and the claimant.
a. The party requesting the IME shall have 30 days from the
date of the failure to agree or respond, to submit an Application
for Independent Medical Examination (IME), Form WC77. Within 10
calendar days of receiving the Application, the Division will
designate a panel (list) of three qualified physicians. The parties
will be notified in writing of the names of the three physicians.
b. The requesting party has 7 business days to strike one name
from the list and notify the other party. The opposing party then
has 5 business days to strike another name, and notify the
Division's IME
unit and the requesting party of the remaining name.
The requesting party must schedule the IME examination with the
selected IME physician within 5 business days of providing and/or
receiving notice of the name of the physician, and must notify the
Division and the opposing party of the date and time of the
examination.
c. If the parties do not complete this process in 15 business
days, the Division will select one name and notify the parties.
Within 5 business days of the physician selection, the requesting
party must telephone the physician and schedule the examination and
then notify the Division and the opposing party of the date and time
of the examination.
5. The carrier must submit medical records to the physician and the
other party at least 14 calendar days before the examination.
6. The claimant must notify the insurance carrier if a language
interpreter is needed at least 14 calendar days before the
examination.
7. The requester must make payment to the IME physician at least 10
calendar days before the examination.
8. The physician is required to mail the IME report to the parties
and the Division within 20 days of the examination.
9. If the requester wishes to cancel the IME process, the requester
must contact the IME Section of the Division immediately.
If you have any questions, or need a Notice and Proposal To Select
An Independent Medical Examiner and Application for Independent
Medical Examination (IME), or any other forms, contact the Division
of Workers' Compensation Customer Service Unit.
What if I am unable to pay the cost of an IME?
If you are unable to pay the $675.00 cost of an IME, you may request
that a judge of the Office of Administrative Courts determine
whether you meet the financial requirements for indigence. The
purpose is to ensure that no one is prevented from prosecuting a
claim for benefits because of inability to pay the required fees.
If you are claiming inability to pay, you must file an
Application for Indigent Determination
form, WC035 IME, within 20 days after submitting the Notice and
Proposal for Independent Medical Examiner form. For additional
information and forms, contact the Customer Service Unit.
